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Terms:

# Hospitation: Clinical attachment or externship. This is a training period in a hospital in which you are allowed to attend rotations, talk with patients, take history, withdraw blood, among other things. In some hospitals, you are allowed to participate as an assistant in operations during the Hospitation in surgery departments.

How to get a Hospitation in a German hospital? You can read the following article:

# Approbation: German Medical License: Allowance to work as doctor in all Germany. If you get this from any Approbationbehörde (see the next definition) in Germany, then this is valid in all German states. After three years of working experience in Germany, this license is also valid in all European Union (Not sure though of how many years of working experience in Germany are required)

# Approbationbehörde: Medical Licensing Authority. There are 16 German states but there are 23 Medical Licensing Authorities. An authority could be responsbile for certain regions of a German state or a for a whole German state. For example, in the German State of North Rhine-Westphalia (Population at the end of the year of 2013 of 17.6 Million, source: Wikipedia), there are five medical licensing authorities.

# Approbation for graduates of European Union: It is granted very easy. They need only to prove knowledge of the German Language in B2 level. Some authorities are now requiring a proof of the knowledge of both the general german language in level of B2 and a level of knowledge of C1 in Medical German. For this, there is a certificate called Telc B2-C1 (More about this certificate in the next point). In other authorities, B2 is enough to apply for Approbation but the graduate of the European Union need to do a medical German language test.

# Graduates from universities outside of the European Union (The so-called third-countried – sogenannt Drittstaaten): In other words, doctors who got their medical degrees NOT from universities in Germany (1) or in the European Union (2) but from any other country. This has nothing to do if the country is a third-world (developing) country or not and the nationality of the applicant does not play a role. What plays a role is the country of graduation if in Germany or the European Union or not.

Knowledge of the German Langauge as explained in the point above apply to them. However, their medical degrees are not recognized. They need therefore to do by most Medical License Authorities a German medical knoweldge Test (Kenntnisseprüfung oder Gleichwertigkeitsprüfung) (difficulty is differnt from one authority to another and the topics of the exam are differnt too but in general Internal Medicine and Surgery).

The articles of this doctor and his group are great and I recommend them but the problem is that most posts are in Arabic.

N.B. I added my opinion (text colored green) where I thought I have some experience and all the links in the translation are from me so as to help the understanding. Otherwise, I think that what the author worte is accurate (colored in blue). However, please keep in mind that the laws always change and that many times there are exceptions and some employee in the same authority might accept something and others might not accept it.

And in gerneral, the competition is now increasing and thousands of foreign doctors are now flowing to Germany.

Germany was opened for foreign doctors in the last 4-5 years and Arab doctors were among the first know that. Mostly, Syrians, Egyptians, Libyans and Jordanians. What is very interesting for me, is that I think that Indian and Paktistani doctors do not seem to know a lot about this route of residency and they are not seen in the scene although they represent at least one fifth of the world population. In the statistics of the year 2013 about foreign docotrs in Germany (link), there are only 202 Indian doctors working in Germany and Pakistani doctors are not mentioned and included under “other nationalities from Asia”. Through the messages and comments that I get in my Blog and my group, the majority of those who ask are from those two countries in addition to Nigeria. A small poll that I published in my group a few days ago confirms that (13 out of 25 doctors who answered the pull come from India and Pakistan) (Link to the pull in Doctors Going to Germanyl). Of course, there is a selection bias in this poll as Arab doctors and Greek doctors, for example, have their very large groups and are little represented in my group.

Before 2-3 years, Jordanian doctors used to get jobs in Germany in less than three months with only B2 level (that is to say, with a modest German language level) and after sending few job applications. Moreover, back then some doctors sent applications for Hospitations and they got offers for contracts instead because of the low number of applicants. Now, getting a Hospitation is very hard and my colleagues in Jordan send hundreds of E-Mails to get a Hospitation.

Dr. Ashour’s article (What he wrote is in blue. My comments are in green):

Please do not apply in no way to get your Approbation in the following regions: 1. The German state of Baden-Wütumberg. 2. The District Government (Bezirksregierung) of Düsseldurf 3. The Distric Government (Bezirksregierung) of Köln

These three do no give equivalence of the medical degrees (=Gleichwertigkeit) and when the result is “not equal (nicht gleich)” you will be stuck with them and you must do a Medical Knowledge Exam in order to be given the Approbation. This exam is very hard and the possibility of not succeeding in it is very high. Moreover, when you apply in another Approbationbehörde, this will affect you negatively.

The easiest two Approbationbehörden to get approbation without any exams are Leipzig and Dresden in the German State of Sachsen BUT YOU NEED TO HAVE EINSTELLUNGSZUSAGE (A paper from a hospital that they accepted you as a residence to work in it) from a hospital in an area that is part of these regions. The advatages of these two are:1. Only B2 is enough to apply for Approbation.2. After the result is gleich (equivalent), you do not have to do a medical german language test (Fachsprachenprüfung) like in [the Distric Governments of] Arnsberg, Detmold, or Münster (What is this exam? It is carried out by the Doctors Chamber (Ärztekammer) in Münster and its official website is here: www.aekwl.de/index.php?id=5346). This exam is necessary to get Approbation or Berufserlaubnis in these distric governments. You will get equivalence of your studies in these distric governemnts but you need to have Einstellungszusage to apply for Approbation.[[[I disagree with the author in two points:

A. The equivalence of studies is not 100% guaranteed. I would say that 80% get equivalence of the studies when talking about graduates of Jordan, Egypt and Syria. However, I was told that the rate of non-equivalence is now increasing. Moreover, the Fachsprachenprüfung is now becoming harder and the failure rates are increasing. Questions are now asked about investigations and mangement and it is not only simply taking a histroy then writing and presenting it.

B. In the District Government of Arnsberg, a proof of Hospitation of at least two months is enough to apply for Approbation. See the full requirements here: amanfrommoab.com/2014/10/21/experience-applying-approbation-bezirksregierung-arnsberg-2014-10-21 ]]]But for the colleague who have Egyptian or Iranian Master, then the best palce is the German States of Türingen. There they will receive the Approbation in one month at most after applying for it. But to apply for Approbation they need a medical language certiface of any kind (B2-Medizin-Telc or Patientenkommunikationtest). They also need an Einstellungszusage.

The procedures of obtaining the Approbation in Thüringen is about 1 Month while in the rest of regions is about 3 Months.

[[[My personal experience and that of at least 10 Jordanian doctors who applied in Arnsberg since last June: The procedures now lasts at least 4-5 Months. Or in average 5 +/- 1 Month. The procedures were fast in the past and before about 15 months they even lasted about two months]]]

And for those who ask if there are availabe jobs? Yes, the jobs are available and everyday I see Ads for all specialties but of course more in certain specialties. What matters in the acceptance for the job is your proficiency of the German language (How good you speak German) better than previous experience and any Approbation.

[[[Regarding the factors that help in getting a job, I totally agree that the proficiency in the German langauge is extremely important. However, now it is extremely hard to get a job interview without Approbation. Even all recruiting companies that I saw do not accept to work with doctors who do not have Approbation no matter how good German they speak. I was told that Approbation is always required. In another point, workign experience, especially in surgical speciatlies, and even if this experience is outside of Germany, is a great advanatage and it will greatly help favor your application. In addition, Hospitation experinece in Germany is important in terms that you had learnt how to take history, do physical examination, do Aufklärung (explaination of procedures), knowing the German Health system. Finally, your personality and your dealing with the patients and your supervisors is extremely important and if the patients and your workign colleagues, nurses and colelagues, loved you, then your supervisors would stick to you and recruit you. In University hosptials, research is important but would not be useful if your German is not good and you cannot do the work recuired from a resident. Many German medical students do research in medical school, in order to get the MD title, and it is not very hard that doctors with no research experience to learn to do that. More importantly, how significant and useful is a research experience in third world countries? What is the percentages of reearches that could be done there and are published in famous journals with high Impact Factors? Also most researches from third world countreis, as the situation is in some countries I know, and I have the right to generalize, then are limited mostly to cross-sectioanls studies and have very limited funding. From my experience, I looked into researchce that are done in Neurogoly and Psychiatry in Germany, and the greatest majority are related to Molecular Biolgoy and/or use MRI or PET and other famous investigations]]]

The translated article and my comments to it end here.
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The required documetns for Approbation are different from one authority to another. However, there are a lot of similarities in the required documents. If you do not know in which authority you will apply for Approbation, then you can read the following required documents as examples so as to help guide you in preparing your documents:

Finally, I think that the situation of granting the Approbation in Germany is unfair. Firstly, one need to have an Einstellungzusage (being accepted as residence) in order to apply for Approbation in all but two or three medical licensing authorities. Cannot the doctors apply without that especially that it is very hard to get a job without Approbation? Moreover, some doctos get the Approbation very quickly and easily and others need to do hard Medical Knoweldge Exams. Even the Medical Knowledge Exams are harder in some authorities and very easy in others. I think that it would be best for the German health system if a German version of the medical licensing exams of the United States (USMLE) was developed for whole Germany!

In case of a unified exam, the application procedures would be easier and graduates from the universiteis outside of the European Union would not waste their time trying to solve the mystery of the required docuements to apply for Approbation, or if what for exams they will to have to do, or what are the required topics to be studied for exams. Instead, they would invest their time studying medicine in German because they know that the topics to be studied and they would know that no excpetions would be made and all need to do a medical knowledge test. Moreover, foreign doctors would not be exploited by Agents who take thousands of Euros promising them of false job offers. For example, I was contacted by an Agent from a developing country who wanted to advertise in my Blog for his services for doctors from his country. He wanted more than 10,000 Euros in return for few medical German courses, help in applying for Approbation, Hospitation for one or two months, in addition to minorities (e.g., networking activities with German doctors!!!). This is crazy! The foreign doctor, if he knew all of the information about the German Residencz route, then he can do such things and would not cost him more than 1000 Euro but of course more time to search. But 10,000+ Euro?!

I think that such a unified exam might be decided upon in the future… but not the near one! I never heard or read about a discussion about a unified exam. Another reason is that the decisions in Germany regarding issues of forieng doctors in the German health system seem seem to take a lot of time. For example, in June of 2013, the German Health Ministers decided that all foreign doctors who want to work in Germany need to prove their knowledge of the German Medical Lanaguge (For example, like in Telc B2-C1 Medical Certificate).

Until now, I never heard or read of medical licensing authorities that applied that other than in Baden-Wüttumberg. In Arnsberg and Munster, this certificate was required for a period of less than a month last October then they were back to the old rule that B2 alone is enough to apply for Approbation.

I hope somebody has experience with this issue: Many of my friends and me included are looking for work possibilities as doctors in Germany. We have medical diplomas from UKRAINE but we have NO INTERNSHIP year.

In Ukraine it is different from Jordan or Germany. Our last year of medical school (6th year) is all clinical in hospitals just like any other country, but officially it is not considered as an ‘internship year’.

Do you know any cases for doctors from countries such as Russia, Ukraine, Georgia, Armenia, etc that bypassed this issue and completed approbation without being forced to return to the country which gave them their diplomas and continued until they did internship completely?

Thank you for your nice and well-written comment. Unfortunately, I have never had exchange of information with doctors who graduated from the countried that you mentionend. The only thing that I could suggest is that you post your questions in the different Faccebook groups related to the specialization in Germany. I am sure you would get help.

@ Dr. George. I’m studying my M.D. in Russia . I really don’t know about whole Russian universities but all I know that last year i.e. 6th year is called internship year. and in Russia university provides our internship certificate issued by Doctors who are permently working there. I’m actually Indian so all I know that in India new doctors who were pass MBBS / MD /MS will get a certificate of practice which indicates time of internships.

I studied dentistry in Philippines and i graduated in 2014,I would like to find a place to practice dentistry in Germany and to take approbation exam.Kindly inform me what are the steps to be authorized dentist in Germany and how can i start the processing ?

Hello,
I applied in arnsberg two months ago and I’m still waiting for a reply. Do you know any Jordanian doctors who recently ( or in the last few months) applied in arnsberg and if they got the “Gleichwertigkeit ” ? I studied medicine in Jordan , at JUST to be more specific. Thank you for your help

So, Fadi Balbisi, this is your third comment in my Blog. Right? 🙂 Unfortunately, no, I do not. I only know that there is now a central Gutachter in Bonn. But hopefully, this should not change the situation. Hopefully, you could get it! And as I sad, the hospital should wait to give you the Stelle. Or you could easily with Approbation get a new Stelle! Good luck 🙂